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WO2018101858A1 - Dispositif d'endoprothèse personnalisée des os du squelette et procédé de son montage - Google Patents

Dispositif d'endoprothèse personnalisée des os du squelette et procédé de son montage Download PDF

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Publication number
WO2018101858A1
WO2018101858A1 PCT/RU2017/000873 RU2017000873W WO2018101858A1 WO 2018101858 A1 WO2018101858 A1 WO 2018101858A1 RU 2017000873 W RU2017000873 W RU 2017000873W WO 2018101858 A1 WO2018101858 A1 WO 2018101858A1
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WIPO (PCT)
Prior art keywords
endoprosthesis
bone
tendons
personalized
patient
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Ceased
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PCT/RU2017/000873
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English (en)
Russian (ru)
Inventor
Андрей Николаевич НИКОЛАЕНКО
Александр Владимирович КОЛСАНОВ
Николай Владимирович ПОПОВ
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Individual
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Individual
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Priority to EP17876462.7A priority Critical patent/EP3549539A4/fr
Publication of WO2018101858A1 publication Critical patent/WO2018101858A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A61B17/8066—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for pelvic reconstruction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30721—Accessories
    • A61F2/30734—Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30576—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs
    • A61F2002/30578—Special structural features of bone or joint prostheses not otherwise provided for with extending fixation tabs having apertures, e.g. for receiving fixation screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30667—Features concerning an interaction with the environment or a particular use of the prosthesis
    • A61F2002/30688—Means for allowing passage or sliding of tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30777—Oblong apertures
    • A61F2002/30779—Oblong apertures arcuate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30772—Apertures or holes, e.g. of circular cross section
    • A61F2002/30784—Plurality of holes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A61F2002/30948—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using computerized tomography, i.e. CT scans
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30942—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
    • A61F2002/30962—Designing or manufacturing processes for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques using stereolithography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2002/30985—Designing or manufacturing processes using three dimensional printing [3DP]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00—Products made by additive manufacturing

Definitions

  • the invention relates to medicine, namely to traumatology and orthopedics, neurosurgery, maxillofacial surgery and dentistry ' and can be used to model an individual endoprosthesis of tubular and flat bones of the skeleton, bones of the facial section of the skull and spine in the treatment of patients with tumors, as well as tumor-like diseases and bone injuries in adult patients.
  • the closest to the claimed invention in its technical essence is a method of manufacturing individual orthopedic implants according to the application AU2015226831 (A1), published WO2015131234 (A1) with priority 20140304.
  • Three-dimensional scanning of bones is performed according to the patent, from which the resected bone segment is virtually removed, a three-dimensional digital model is obtained unresected bone segment and, comparing the three-dimensional digital image of unresected and the corresponding three-dimensional digital image of the resected bone segment, evaluates The volume of bone that has been removed.
  • Estimated Remote Volume The segment is used for the manufacture of individual orthopedic implants, which essentially corresponds to the volume configuration of the resected bone tissue; the implant is precisely integrated to significantly restore the biomechanical function of the bone.
  • the present invention is aimed at obtaining the following technical result: reducing the terms of restoration of the anatomy of the removed segment of the affected bone, as well as reducing the time of functional and social adaptation of patients by determining the exact volume of the removed segment of the affected bone and providing the possibility of manufacturing an endoprosthesis with individual fixation points of muscles, tendons and the joint capsule of the patient.
  • the device of a personalized skeleton bone endoprosthesis consists of a prosthesis body repeating the individual architectonics of the prosthetic bone of the patient and at least one fastening element characterized in that it is equipped with individual fixation points for muscle tendons, representing a bed for the surgical needle and jumpers for fixing the tendon with surgical thread.
  • the method for installing a personalized skeleton bone endoprosthesis is as follows: before surgery, on the basis of computed tomography performed with contrast enhancement, a virtual three-dimensional model of a piece is created that accurately follows the contours of the resected bone and allows for segmental resection of its affected part, as well as a personalized endoprosthesis with the intended individual fixation points of the muscles, tendons and joint capsule of the patient, then reproduced in the material yes Noe and pattern personalized prosthesis with desired characteristics, and then the one stage surgery after surgical resection of access to the zone pattern superimposed on the resected segment and perform filing, wherein the segmental bone resection is performed strictly according to the patterns, and the circuit is completely Endoprosthesis corresponds to the contour of the resected bone, after which the endoprosthesis is installed and the tendons of the muscles are fixed to individual points.
  • the proposed method for installing a personalized skeleton bone endoprosthesis is performed in one stage of surgical intervention: removal of the affected bone segment by resection according to an individual pattern, and then personalized endoprosthetics are performed, which reduces the consequences of the patient’s surgical injury.
  • the available individual fixation points for muscles, tendons and articular capsules allow the muscles to take their physiological position, which was originally.
  • the individual fixation points for muscles, tendons and articular capsules represent a bed for the course of the surgical needle and a jumper for fixing the tendon with surgical thread.
  • the monofilament surgical suture resolves after 30 days, while the tendon tissue manages to integrate into the bioactive coating of the endoprosthesis and acquires a physiological position.
  • the proposed method of personalized endoprosthetics can be used at the stage of reconstruction of lost anatomical bone segments during extensive operations in patients with tumors and tumor-like diseases, as well as trauma, both for prosthetics of tubular bones and for prosthetics of flat skeleton bones and allows more accurate calculation of the volume of tissues removed intraoperatively, maximize the reconstruction of the removed bone segment by installing a personalized endoprosthesis with individual points fixation of muscles, tendons and articular capsule, and, as a result, restore the bone anatomy more fully.
  • a personalized endoprosthesis with individual fixation points for muscles, tendons and a joint capsule can be made, for example, by selective laser sintering of a material - titanium fine powder of the VT1-00 brand according to TU 1791-001-1 1805089-2014, the chemical composition of the powder corresponds to GOST 19807-91.
  • the personified endoprosthesis made by the above method has an individually selected anatomical contour and curvature of the articular surfaces. Conducted segmental bone resection is performed strictly according to the pattern, for more accurate compliance with the resection parameters. The contour of the endoprosthesis fully corresponds to the contour of the resected bone.
  • a bioactive coating is applied to the surface of the endoprosthesis at the points of contact with soft tissues, which improves integration.
  • a personalized endoprosthesis of skeleton bones consists of the body of the prosthesis and at least one fastener. The number and type of fasteners depends on the type of prosthetic bones, i.e. tubular or flat bones of the skeleton.
  • the body of the prosthesis completely repeats the individual architectonics of the patient’s prosthetic bone and is equipped with individual fixation points for the patient’s muscles, tendons and joint capsule, which allows the bone anatomy to be completely restored. Individual muscle fixation points represent a bed for the course of the surgical needle and a jumper for fixing the tendon with surgical thread.
  • the device of a personalized endoprosthesis of skeleton bones is presented on the example of an endoprosthesis of bones of the anterior semicircle of the human pelvis.
  • the endoprosthesis of the bones of the anterior semicircle of the pelvis like the pubic bone, consists of the upper branch, lower branch, body of the endoprosthesis.
  • the endoprosthesis is attached to the pelvis using the fixing legs, each of which corresponds to the shape of the patient’s bone.
  • an endoprosthesis with fastening legs completely repeats the complex individual architectonics of the pelvic ring.
  • the endoprosthesis provides individual points of fixation of muscles and tendons, outlined with the help of special 3D-modeling programs.
  • the surface of the endoprosthesis, at the points of contact with soft tissues, has a bioactive coating that improves integration.
  • the personified endoprosthesis has an individually selected anatomical contour and curvature of the articular surfaces.
  • the performed segmental resection of the bone is performed strictly according to the individual pattern, for more accurate compliance with the resection parameters.
  • the contour of the endoprosthesis fully corresponds to the contour of the resected bone.
  • FIG. 1 General view of the pelvic ring with an endoprosthesis
  • FIG. 2 endoprosthesis of a segment of the pelvic ring
  • FIG. 3 pattern for resection of the pelvic ring
  • FIG. 4 pelvic ring with a superimposed pattern for resection and sawing planes.
  • the figure 1 shows the endoprosthesis 1, the pelvic ring 2.
  • the figure 2 shows the body of the endoprosthesis 3, the upper branch 4, the lower branch 5, the fixing foot (ipsilateral pubic bone) 6, the fixing foot (ischial bone) 7, the fixing foot (contralateral pubic bone) 8, fixing screws 9, fixation points 10.
  • the curve 1 is shown.
  • Figure 4 shows the pelvic ring 2, curve 11, the sawing plane 12.
  • the proposed method for installing a personalized skeleton bone endoprosthesis is performed as follows: before surgery, the patient undergoes computed tomography with contrast enhancement Omnipak 50 ml, on the basis of which a virtual three-dimensional model of a 1 1 curve is created that accurately repeats the bone contours for segmental bone resection and a personalized endoprosthesis model 1 with targeted individual fixation points of 10 muscles, tendons and joint capsule of the patient, applied with etsialnoy computer program. After that, the data is transferred to the STL format with subsequent processing in the control program of the 3D printer. Then, with the given characteristics, patterns 1 1 (Fig. 3) and endoprosthesis 1 (Fig.
  • stereolithographic printing of the pattern 1 1 is performed for resection by heat-resistant two-component polyurethane and endoprosthesis 1, for example, from titanium powder of the VT1-00 brand on a 3D printer.
  • the surgeon imposes a piece 1 1 on the resected segment of the pelvic ring and performs filing on the planes 12 (Fig. 4) at three points with a saw.
  • the thickness of the working surface of the saw blade (0.3 mm) is taken into account.
  • the removed bone fragment is sent for histological examination.
  • the reconstruction stage installation of the endoprosthesis 1.
  • the endoprosthesis 1 of the bones of the pelvic ring 2, as well as the pubic bone of the pelvic ring 2 of the patient, consists of the upper branch 4, the lower branch 5 and the body of the endoprosthesis 3.
  • the endoprosthesis 1 is fixed to the pelvic ring 2 of the patient using fixing lapocb, 7, 8, each of which corresponds to the patient’s bone (Fig. 1).
  • the fixing foot 6 for the ipsilateral pubic bone that is, on its side
  • the mounting foot for matching with the sciatic bone 7 and the mounting foot 8 for the contralateral pubic bone that is, on the opposite side (Fig. 2).
  • the tabs are attached using screws 9 through holes with a diameter of 5.0 mm in the mounting tabs 7, 8, made in the form of thin plates with a thickness of 2.0 mm.
  • Fixing legs 6, 7, 8, repeat the completely complex individual architectonics of the pelvic ring 2 the patient.
  • the fixing tab 8 closes the anterior half ring, passing to the contralateral pubic bone.
  • the endoprosthesis provides fixation points 10 for muscles and tendons attached to the segment of the anterior semiring of the pelvis 2 of the patient.
  • the individual fixation points of 10 muscles, tendons and articular capsules represent a bed for the course of the surgical needle and a jumper for fixing the tendon with surgical thread. After suturing the tendons to the fixation point 10, the monofilament surgical thread resolves after 30 days, while the tendon tissue manages to integrate into the bioactive coating of endoprosthesis 1 and acquire a physiological position.
  • the set of features is new and allows, at one stage of the surgical intervention, to perform bone resection and installation of a personalized endoprosthesis of the lost bone segment, while reducing the period of functional and social adaptation of patients.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Surgery (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Cardiology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Geometry (AREA)
  • Manufacturing & Machinery (AREA)
  • Neurology (AREA)
  • Physics & Mathematics (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne la traumatologie et l'orthopédie, la neurochirurgie, la chirurgie maxillo-faciale et la stomatologie. L'endoprothèse personnalisée des os du squelette sous la forme d'un corps de prothèse reprend l'architectonique individuelle de l'os recevant une prothèse du patient et de l'élément de fixation. L'endoprothèse est munie de zones de fixation des ligaments conformément aux zones de fixation des ligaments du patient qui se présente comme un logement pour la course de l'aiguille chirurgicale et un raccord de fixation du ligament au moyen d'un fil chirurgical. Le procédé de montage de l'endoprothèse personnalisée des os du squelette comprend : avant l'intervention chirurgicale, et sur la base d'une tomographie informatique réalisée avec une amplification de contraste, on crée un modèle tridimensionnel virtuel l'endoprothèse personnalisée reprenant l'architectonique individuelle de l'os du patient recevant une prothèse. En outre, on crée un modèle tridimensionnel virtuel d'un motif qui permet d'effectuer une résection par segments de la partie affectée de l'os. On reproduit dans un matériau ledit motif et l'endoprothèse personnalisée. En un stade d'intervention chirurgicale, après l'accès chirurgical à la zone de résection, on applique le motif sur le segment de l'os à réséquer et on effectue un limage de l'os en suivant strictement le motif. On installe ensuite l'endoprothèse et on fixe les tendons des muscles à l'endoprothèse dans les zones susmentionnées de fixation des tendons. L'invention permet d'assurer une diminution de la durée de restauration de l'anatomie d'un segment retiré de l'os affecté, ainsi qu'une diminution de la durée d'adaptation fonctionnelle et sociale des patients grâce à à la détermination du volume précis du segment à retirer de l'os affecté, et la préparation d'une endoprothèse ayant des points individuels de fixation des muscles, des tendons et des capsules vasculaires du patient.
PCT/RU2017/000873 2016-11-29 2017-11-24 Dispositif d'endoprothèse personnalisée des os du squelette et procédé de son montage Ceased WO2018101858A1 (fr)

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EP17876462.7A EP3549539A4 (fr) 2016-11-29 2017-11-24 Dispositif d'endoprothèse personnalisée des os du squelette et procédé de son montage

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RU2016146763 2016-11-29
RU2016146763A RU2651104C1 (ru) 2016-11-29 2016-11-29 Способ моделирования и устройство персонифицированного эндопротеза костей скелета

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DE102021118087A1 (de) * 2021-07-13 2023-01-19 Ot Medizintechnik Gmbh Symphysenknochenplatte und Set

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EP3549539A1 (fr) 2019-10-09
EP3549539A4 (fr) 2020-04-01
RU2651104C1 (ru) 2018-04-18

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